Laparoscopic partial fundoplication after lung transplant in a patient with severe esophageal motility disorders (scleroderma)
Epublication WebSurg.com, Mar 2009;09(03). URL: http://websurg.com/doi/vd01en2552
Gastroesophageal reflux disease (GERD) is prevalent among patients with end-stage lung disease before and after lung transplantation. In addition to problems with the lower esophageal sphincter, systemic diseases such as scleroderma and cystic fibrosis can diminish esophageal and gastric motility. After thoracic transplantation, esophageal and gastric motility often are negatively affected by damage to the vagus nerve and certain medications. Remodeling of the thoracic cavity also may alter the mechanics of esophageal muscle contraction. After transplantation, fundoplication may improve pulmonary function and prevent complications such as bronchiolitis obliterans syndrome. This is the case of a 57-year old patient with scleroderma 8 months after lung transplantation for idiopathic pulmonary fibrosis (IPF). The patient presented with typical GERD symptoms, not responsive to a high dose of PPI. The trocar placement is the same as for a standard Nissen fundoplication. The video shows each surgical step carefully and demonstrates how to correctly perform esophageal and mediastinal dissection in case of a previous lung surgery.